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Family and Children's Medicaid MA-3255 NC HEALTH CHOICE

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VI. ONGOING CASE MAINTENANCE

TYPE OF CHANGE

ACTION REQUIRED?

COMMENTS

Address of entire AU changes

Yes

Change address in EIS

NCHC child leaves the home; other children remain

The child moves into household not authorized for NCHC

The child moves into another NCHC household

No

No

No

No change in case until reenrollment. Child remains in the AU

Evaluate eligibility at reenrollment.

At end of child’s enrollment period, add to remainder of NCHC period in new household if the child is ineligible for Medicaid. Update needs unit and maintenance amount. Do not change classification or income.

Child not authorized for NCHC or Medicaid enters NCHC household

Yes

Evaluate for Medicaid. If ineligible for Medicaid and child does not have comprehensive insurance, add to NCHC case. Update needs unit and maintenance amount. Do not change classification or income.

Child receiving Medicaid has change in situation and Medicaid is terminated.

Yes

If no NCHC case for household, evaluate child for NC Health Choice. If eligible, approve administrative application for NCHC.

If others in household already receiving NCHC and MA child does not have comprehensive insurance, complete add-on application to approve NCHC for this child. Update needs unit and maintenance amount. Do not change classification or income.

One child is deleted (no longer eligible) from NCHC case which has more than one child.

Yes

In EIS, adjust needs unit and maintenance amount. Do not change classification or income.

Budget unit member not authorized for NCHC leaves the home permanently.

No

Evaluate eligibility at reenrollment.

Family moves to another county

Yes

Complete county transfer in EIS. 2nd county does not have to review until reenrollment.

Income increases above 159% of FPL or below 211% of FPL

No

No change until reenrollment.

Income decreases to below MIC income limit

No

No change until reenrollment, unless beneficiary requests termination to allow them to apply for Medicaid.

Child moves out of state

Yes

Terminate if only case member. Delete if other children are in the NCHC case. Do not change classification or income.

REISSUED 04/01/14 – CHANGE NO. 02-14

CHANGES IN HOUSEHOLD SITUATION

TYPE OF CHANGE

ACTION REQUIRED?

COMMENTS

Classification code erroneously used

Yes

Change during enrollment period unless 2 or fewer months prior to reenrollment.

Child acquires comprehensive health insurance (including Medicare)

Yes

Follow instructions for child moves out of state.

Child dies

Yes

Follow instructions for child moves out of state.

Child is incarcerated

Yes

Follow instructions for child moves out of state.

Child becomes eligible for Work First

Yes

Follow instructions for child moves out of state.

Child is removed by DSS and is eligible for HSF/IAS.

Yes

Delete or terminate. Approve HSF/IAS.

If child is later returned to parental custody during same NCHC enrollment period complete an administrative reapplication against the terminated NCHC case id (or add to existing a.u.) using the original date of application and the original certification period to authorize NCHC for the remainder of the original enrollment period. The effective date of coverage is the month following month of HSF/IAS termination.

Child becomes SSI eligible

Yes

System will authorize child for Medicaid. If other children remain in the NCHC case, change the # in the needs unit and maintenance level. Do not change classification or income.

If child’s SSI stops during original NCHC enrollment period, complete an administrative reapplication against the terminated NCHC case id (or add to existing a.u.) using the original date of application and the original certification period to authorize NCHC for the remainder of the original enrollment period. The effective date of coverage is the month following month of SSI MA termination.

Head of Household requests termination

Yes

Terminate case

Child marries

No

Leave in the NCHC case.

Child turns age 19

Yes

Delete or terminate child

Child enters Long Term Care

Yes

Evaluate for Medicaid. If eligible, delete or terminate NCHC and approve Medicaid. If ineligible for Medicaid, continue NCHC coverage.

NCHC beneficiary becomes pregnant

Yes

Evaluate for Medicaid. If eligible, delete or terminate NCHC and approve ongoing Medicaid. Contact Claims Analysis Section at DMA if eligible for Medicaid coverage of “retroactive” pregnancy related services received during months of NCHC eligibility. Do not attempt to enter eligibility in EIS for these months. If ineligible for Medicaid, continue NCHC coverage.

REISSUED 04/01/14 – CHANGE NO. 02-14

(VI.)

REISSUED 04/01/14 – CHANGE NO. 02-14

(VI.C.)

REISSUED 04/01/14 – CHANGE NO. 02-14

(VI.C.)

REISSUED 04/01/14 – CHANGE NO. 02-14

(VI.C.12.a)

REISSUED 04/01/14 – CHANGE NO. 02-14

(VI.C.)

REISSUED 04/01/14 – CHANGE NO. 02-14

(VI.F)

REISSUED 04/01/14 – CHANGE NO. 02-14

(VI.G.)

REVISED 04/01/14-CHANGE NO. 02-14

(VI.H)

REVISED 04/01/14-CHANGE NO. 02-14

(VI.I.)

REISSUED 04/01/14-CHANGE NO. 02-14

(VI.I.)

REISSUED 04/01/14-CHANGE NO. 02-14

(VI.I.9)

REVISED 04/01/14-CHANGE NO. 02-14

(VI.J.2.b.)

REISSUED 04/01/14– CHANGE NO. 02-14

(VI.J.3.b.)

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